Download Eating and Living With Dignity- A Practical Guide for Caregivers and

Eating and Living
With Dignity
A Practical Guide for Caregivers and
Family Members of Persons with Dementia
Information and Recommendations
The National Program for Addressing Alzheimer's
Disease and Other Types of Dementia
2
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Eating and Living
With Dignity
A Practical Guide for Caregivers and Family
Members of Persons with Dementia
Information and Recommendations
This booklet was written by professionals at the Ministry of Health, through multidisciplinary
cooperation. Dietitians, occupational therapists and a speech and language therapist participated in
the writing, with the assistance of a social worker and a nurse, in order to collect and complete the
information.
Writing undertaken by:
Ms. Yosefa Kachal – Dietitian (MPH, RD) – Geriatric Nutrition Coordinator, Department of Nutrition,
Ministry of Health
Mr. Avidor Ginsberg – Dietitian (BSc, RD) – Information Scientist at the Department of Nutrition,
Ministry of Health
Ms. Orly Bergerzon Biton – Speech and Language Therapist (MA, SLP) – National Auditing
Coordinator of Speech and Language Therapy, Division of Geriatrics, Ministry of Health
Ms. Sarit Rabinovitz – Occupational Therapist (MSc, OT) – National Auditing Coordinator of
Occupational Therapy, Division of Geriatrics, Ministry of Health
Dr. Maayan Katz – Occupational Therapist (PhD, OT), Deputy Director of the National Occupational
Therapy Service and Geriatrics Coordinator, Ministry of Health
Participation in the undertaking:
Ms. Malka Prager – Social Worker (MA) – Director of the National Social Work Service, Ministry of
Health
Dr. Dorit Rubinstein – Nurse (PhD, RN) – National Superintendent Nurse in Audit of Geriatric
Services, Division of Geriatrics, Ministry of Health
Editorial assistance:
Dr. Iris Rasooly – Physician (MD MPH – Public Health and Medical Administration Specialist),
Director of the Department of Community Geriatric Services, Division of Geriatrics, Ministry of Health,
in the team spearheading the National Program for Addressing Alzheimer's Disease and Other Types
of Dementia
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
3
Eating and Living With Dignity –
A Practical Guide for Caregivers and Family Members of Persons with
Dementia – Information and Recommendations
Introduction
Food and eating play an important role in maintaining quality of life, providing pleasure, as well as
their important role in maintaining health. Eating is very significant throughout a person’s lifetime, even
when it seems to us that the person is not functioning at all; eating is one of the last functions that
are preserved.
Persons with dementia experience difficulties in nutrition and eating, which pose a substantial
challenge for caregivers. These difficulties appear even in the early stages of the disease, but become
worse as it progresses. More often than not, coping with eating difficulties causes great frustration for
the primary caregivers and requires reorganization around meals throughout the day.
In view of this, the need arose to provide solutions for family and caregivers to deal in a dignified
manner with the eating difficulties that characterize the various stages of dementia.
These information sheets focus on the eating and nutritional challenges of persons with dementia,
and provide practical guidance and assistance to all caregivers, including family, caregivers in
the framework of the Nursing Law, foreign caregivers, instructors of support groups for families,
employees at long term care facilities etc. The objective is to provide adequate nutrition and
safeguard the person’s safety – while maintaining his dignity at the same time.
The information presented in these pages is based on vast experience accumulated in Israel and
around the world regarding this important issue.
At the same time, it is important that you, the caregivers, take care of yourselves and your
health. Sometimes you are so preoccupied and concerned about the patient/your relative, that you
forget to take care of yourself: you do not pay attention to your own diet and physical exercise, and
sometimes even miss family and social events. Without noticing, you might neglect your physical
and psychological needs over time. It is important that you be aware that a long-term condition that
fatigues and drains you could jeopardize your health, to the point where you can no longer take care of
your loved one. Therefore it is essential that you take care of your own health first and foremost.
Remember that healthy nutrition and integrating physical exercise into your daily routine promotes
your health, for your sake and for the sake of those around you.
For more information please read the chapter at the end of the booklet: “Principles of Healthy
Nutrition”
4
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Office of the
Minister of Health
Dear citizens,
Life expectancy in Israel is constantly on the rise, which is a great blessing, but one which is
accompanied by an increasing number of people with dementia who live to an old age. Dementia
patients pose a challenge for the patients’ families, society and the healthcare system. Nevertheless,
both in Israel and around the world, there is a growing tendency for dementia patients to be cared for
by their families at home in the framework of the community. Home care maintains a person’s dignity
at times when the body and mind are feeble.
Within the framework of coping with dementia, we seek to pay attention to the unique aspects of
nutrition and eating patterns of this population, including swallowing difficulties, and how to prevent
or minimize consequent health problems.
Generally speaking, education for good and healthy nutrition promotes health and can prevent illness
in the general population. And this is also our premise – food has an important place in our lives.
Maimonides, as well as many additional important thinkers in Jewish history, have written much about
food products and eating habits in their philosophical, health, and medical aspects. In all his medical
writings, Maimonides repeatedly emphasizes the importance of good eating habits as a necessary
condition for maintaining a healthy body: “One should refrain from things that make the body ill, and
make a habit of things that make one healthy and fit”.
This booklet was written by the multidisciplinary staff at the Ministry of Health in the framework of the
National Program for Addressing Alzheimer's Disease and Other Types of Dementia, spearheaded by
the Division of Geriatrics at the Ministry of Health.
It contains vital information for all those who take care of persons with dementia and for their families.
I hope that this information will encourage them and will alleviate the patients’ suffering.
Wishing you good health,
Knesset Member Rabbi Yakov Litzman
Minister of Health
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
5
Introduction – Head of
the Division of Geriatrics
Dementia is one of the most serious and distressing health problems. Dementia is caused by a
number of degenerative diseases affecting the brain, the most common of which is Alzheimer’s
disease. These diseases cause the ongoing and irreversible deterioration of mental capabilities and
brain function, posing a challenge for the patient and his family. The first symptoms of the disease are
memory loss and impairment in cognitive abilities and orientation, and the person gradually develops
an inability to perform daily activities and communicate with his surroundings. Difficulty with nutrition
and feeding characterizes the advanced stage of the disease. The purpose of this booklet is to be of
assistance and guidance for family members on this subject.
Nutrition is a fundamental and vital part of life for every human being, but for those with dementia,
this simple action becomes complex, complicated and sometimes extremely difficult to perform due
to the disease’s effects – both in terms of health and in terms of behavior. For family members and
other caregivers, this vital action of feeding their loved one sometimes becomes an almost impossible
mission, and they seek help in coping with the multitude of problems they face on a daily basis.
The purpose of this guidance booklet, written by prominent professionals in the Ministry of Health,
including dietitians, occupational therapists, and a speech and language therapist, is to provide
families with tools and methods of coping with advanced stage dementia – both in terms of the
composition and texture of the food itself, and in terms of methods for feeding, when faced with the
challenges it poses for these patients.
I thank the professionals at the Ministry of Health from the Department of Nutrition at Public Health
Services, the National Occupational Therapy Service, the personnel of the Division of Geriatrics –
from the fields of speech and language therapy, occupational therapy, medicine and nursing – and the
Social Work Service, who were part of this initiative, and who worked hard to write, edit and present
this information to the families of dementia patients and to other caregivers.
My thanks and appreciation to the EMDA Association – for patients with dementia, Alzheimer’s and
similar diseases in Israel – which initiates and promotes projects for helping the families of patients
with dementia illnesses, and has done so for this important issue of nutrition and feeding as well.
My thanks to ESHEL – the association for planning and developing services for the elderly in Israel –
which helped with the process.
The booklet is part of the work done in the framework of the National Program for Addressing
Alzheimer's Disease and Other Types of Dementia, led by the Ministry of Health, in cooperation
with the Ministry of Social Affairs, the Ministry for Social Equality, the National Insurance Institute, the
Health Funds and many other bodies.
I wish to express my deepest appreciation for families and other caregivers, who nurse the persons
with dementia devotedly. I am certain that this booklet will contribute to more adequate care in terms
of nutrition and will assist them in their day to day coping with these patients.
Sincerely,
Dr. Aaron Cohen
Head of the Division of Geriatrics
Ministry of Health
6
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Introduction – EMDA –
the Alzheimer's Association
of Israel
As life expectancy and the number of elderly people rise globally and in Israel, so does the number of
persons with Alzheimer's disease.
Alzheimer's disease has been defined as an epidemic and one of the most substantial public health
problems of the 21st century.
This booklet is supplementary to guidance/recommendations for professionals and the general
public, such as the Complete Guide for Persons with Dementia, Alzheimer’s and similar types of
diseases, published by the EMDA Association.
Nutritional guidelines have preventative value for all ages; this is especially true for persons with
dementia.
At certain stages of the disease, nutrition constitutes an important and critical factor in the daily
routine for professionals and family members (primary caregivers), when dealing with the patient
experiencing difficulty eating and swallowing.
We are confident that this guide will serve as an important tool for ways to cope with the disease,
and will ease, at least a little, the many difficulties that the patient’s families and caregivers are facing.
I would like to thank all the members of the committee at the Ministry of Health and the steering
committee members for their devotion and dedication to the matter.
Remember – you are not alone – EMDA – the Alzheimer's Association of Israel – *8889, 035341274
Yona EliadGery Rot
Chairperson CEO
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
7
Introduction – Eshel – JDC
(The association for planning and developing services for
the elderly in Israel)
In recent years, there has been greater awareness of the fact that healthy nutrition is an essential
component of health maintenance and in the prevention of disease, and even contributes to quality
of life. Proper nutrition affects health at any age, and more so at times of sickness or at an old age.
Reduced cognitive function affects judgement regarding food intake, could impair the ability to
purchase food products and cook them, and could even trigger reactions such as refusal to eat.
These difficulties appear even in the early stages of dementia, and become worse as it progresses. In
the disease’s later stages, there is also difficulty eating and swallowing the food.
Difficulties in nutrition and eating are a challenge for professionals, caregivers and family. These
difficulties need to be dealt with on a daily basis, being more often than not a source of frustration for
the caregiver (employed) and/or family member.
The information sheets focus on these difficulties and focus on practical solutions for all those caring
for dementia patients, throughout the stages of the disease.
Prominent professionals from the Ministry of Health, dietitians, occupational therapists and speech
and language therapists have joined forces to compose the information sheets. In this booklet, you
will find information on the signs of eating and swallowing disorders and difficulties, practical advice
and “tips”, including sample menus. The information is based on vast experience accumulated in
Israel and around the world regarding this important issue.
Writing and publishing these information sheets is another important step in the efforts made by JDC
Israel-Eshel – in collaboration with the Ministry of Health and the EMDA Association – to increase
knowledge on the various aspects of dementia at its different stages, and to develop practical and
effective tools that will serve all caregivers and make the lives of dementia patients easier. This is part
of The National Program for Addressing Alzheimer's Disease and Other Types of Dementia, in which
JDC-Eshel participates.
The right professional attitude will help find effective and beneficial solutions for the nutrition of
dementia patients, that will maintain the quality of life of persons with dementia and their caregivers.
Sincerely,
Yossi Heiman Dr. Sara Alon
CEO Eshel-JDC Senior Program Director, Eshel-JDC
8
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Introduction
Department of Nutrition – Public Health Services
Occupational Therapy Service and Speech and Language Therapy
Service – Medical Administration
Eating is a vital need and a very significant activity in the life of every person. Eating, together with all
the required associated activities – shopping, cooking, preparing and eating the food – also carries
with it cultural, social and emotional significance.
Eating is a complex activity, which depends on physical and cognitive functions, sensory functions,
and chewing and swallowing functions. Persons with dementia experience a decline in these
functions. This could markedly impair their enjoyment from eating and from the food and also make
eating less safe, while at the same time preventing participation in important activities that go along
with eating, which in turn can cause social isolation.
A balanced and healthy diet is essential at all ages and at all times, and constitutes an important
component of maintaining good health and quality of life. Lack of a balanced and healthy diet due to
difficulties in eating and swallowing functions could be detrimental to health, leading to conditions
such as pressure ulcers, pneumonia and other infections, health deterioration necessitating
hospitalization – and may sometimes even be life-threatening.
It is therefore particularly important to follow a balanced diet and rules for safe eating with support
and guidance from the family and caregivers.
For the dementia patient, quality of life so far as eating and nutrition is concerned often depends on
healthcare professionals, family members and primary caregivers. For as long as possible, it is very
important to adhere to the wishes and abilities of the person to choose what he wants and prefers to
eat, and to maintain a certain degree of independence, even if their environment needs to be adapted
for that purpose.
This guidance booklet is a product of the joint efforts of dietitians, speech and language therapists
and occupational therapists, who worked together for an important cause – contributing to the
quality of life of persons with dementia, and preventing their social isolation, as far as possible, while
addressing many issues and taking into consideration their health and functional state.
We wish to express our thanks and appreciation for all those participating in the project: people in the
Ministry of Health and other partners who worked hard to realize this important guidance project for
the benefit of the patients and their families.
Sincerely,
Prof. Ronit Endevelt – Director, Department of Nutrition
Orly Boni – Director, National Occupational Therapy Service
Dr. Orly Herzberg – National Speech and Language Therapist
Ministry of Health
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
9
10
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Eating and food intake in the healthy
person – what does it involve?
Eating is a much more complex action than simply putting food in the mouth. It consists of
several stages:
a. Buying the food
b. Preparing the meal
c. Organizing the eating environment – such as setting the table
d. Eating the food
a. Buying and storing the food
This stage begins before the meal itself, when we walk or drive to the market or store, remember what
we wanted to buy, choose what we want to buy, the quantity we need (such as 1 kg of tomatoes and
a loaf of bread), pay, go back home and organize the food in the cabinets and fridge.
b. Preparing the meal
We plan what we want to eat, whether it be a simple meal that doesn’t require special preparation
(slice of bread with cheese) or a more complex meal that requires preparation (such as chopping salad
or cooking soup, baking a pie or frying meatballs). We can cook by a recipe or from memory.
c. Organizing the eating environment (e.g. setting the table)
In a healthy routine, we are able to choose and plan when to eat our lunch, where to eat our lunch
(kitchen? dining room?) and who we want to share our meal with (alone? with friends? with the kids?).
We set the table – spread a tablecloth, select a plate, a glass and utensils (knife, fork, spoon) with
which we’d like to eat.
Usually we can also choose whether we want to eat in a room lit with strong or weak lighting, whether
we want to eat with background music or quietly – and all this even before we begin eating (ambiance).
d. Eating the food
While we eat, we can feed ourselves, we choose the eating pace (slow and relaxed or fast), and we
are able to thoroughly chew and swallow various types of food and beverages. We are able to use our
senses – see, smell and taste the food. Accordingly, we can decide – whether we would like another
piece of pie, more vegetable salad or decide that we don’t want to finish the food on the plate. We are
then able to clear the dishes to the sink and wash the dishes.
Not all of us do all of the actions described above. For example, common practice in many families is
that one spouse does the shopping, while another usually cooks or washes the dishes.
This division of labor is made out of choice and not due to a real difficulty in performing one of the
actions.
The difficulties described below relate to those experiencing difficulties in performing actions they
were used to doing beforehand.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
11
12
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Why do persons with dementia have
difficulty eating?
Dementia itself can affect eating: Dementia is characterized by cognitive changes that progress
with time and that affect comprehension, memory and orientation – each of which has many effects
on eating and nutrition functions.
In the first stages of the disease, when the person with dementia feels that “something is wrong
with him”, there may be reactions of depression, anxiety and disquiet (which may be manifested in
wandering around the house day and night or difficulty sitting in one place and concentrating). These
effects influence eating and food intake. For example, when wandering a lot, the body expends much
energy (calories) and this causes weight loss, even more exacerbated when nutrition is inadequate.
Significant events in the patient’s life could cause emotional difficulty and loss of appetite: For
example, illness or death of spouse or other family members or friends, change in living environment
(such as moving close to the children or to sheltered housing). In addition, social isolation and
absence of purposeful occupation affect nutrition.
Xerostomia (dry mouth): There may be several causes for this: reduced amount of saliva (due to
insufficient fluid intake, medications and so on) combined with changes in saliva composition, making
saliva more viscous. Additionally, elderly persons tend to breath through the mouth, leaving their
mouths open all the time, and the oral cavity becomes dry.
Oral cavity problems: Includes dental problems, problems in palette, gums and tongue. All of these
can affect the choice of type of food, e.g. preferring meatballs over schnitzel, mashed potatoes over
baked potatoes, or refraining from eating foods that are too spicy or sour.
Teeth have a crucial influence on the eating process. Bad and untreated teeth are painful and can
cause difficulty chewing, and dentures that fit poorly on the gums can cause infections and pain.
Infections in the oral cavity (e.g. oral thrush – recognizable as a white coating on the tongue and/or
sores), inflamed gums, jaw pain and so forth – also make eating difficult.
Pain: Pain of any type that bothers or torments a person can affect food intake.
Illness: Including inflammations and infections (such as urinary tract infection and pneumonia) –
could cause general weakness and affect appetite and the ability to swallow.
Medications: Many adults, in particular elderly persons, suffer from multiple illnesses and are
therefore treated with a wide range of medications. Some medications affect various functions:
alertness, thinking, hunger and appetite, swallowing process, and some medications cause nausea
or constipation. As a result, appetite and the desire to eat is affected.
Constipation: Many people, particularly the elderly, complain of constipation, which could be
accompanied by abdominal pain, fullness and flatulence and strain on the toilet (which could cause
hemorrhoids and bleeding). This range of effects causes loss of appetite. Persons with dementia are
sometimes unable to explain in words that they are constipated, but we can see that they are suffering
from this by their expressions and body language.
There are many reasons for eating difficulties in persons with dementia. In many instances,
they can be helped. We recommend consulting the patient’s physician.
Weight changes:
Eating problems in persons with dementia, at the different stages of the disease, could cause weight
loss or even significant weight gain. Therefore, it is important to be weighed once a month.
If there is a weight loss of more than 5 kg over a period of 6 months, contact the patient’s
physician and consult a dietitian.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
13
What are the signs that can indicate
problems with eating and with choosing
food?
Warning signs
Even in the early stages of dementia, difficulties can be identified in each of the four eating
function actions – buying food, preparing the meal, organizing the place where we eat, and
eating the food (as mentioned above).
These difficulties are warning signs, indicating that the person with dementia is not functioning
as he has up till now, and he needs help.
Here are the warning signs for each of the four activities required for eating function.
• The tips and recommendations presented here are
particularly important in the early stages of dementia.
• The nature of the disease and the rate of its progress
vary from one person to another, so there is no single
solution that fits everyone and for all circumstances.
Note: These tips can also help the healthy population and people suffering
from various disease not related to dementia.
14
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
a. Buying and storing food
Does grocery shopping take too long?
Does the person shop for groceries in a disorganized and inefficient manner? For example, does
he buy fruits and vegetables, then buy dairy products and then go back to buy more vegetables?
Does the person have trouble handling money? For example, does the person with dementia fill
a whole cart with groceries even though he has only ten Shekels in his wallet?
Does the person have difficulty choosing the groceries? For example, buying ten packets of
margarine while forgetting to get what he really needs: milk, eggs, vegetables, bread.
Does the person go shopping for groceries often, but there is only a small amount of food in the
house?
Has there been a change in the choice of foods that the person buys and eats? For example,
does a person who always ate the same kind of bread and made sure to buy only soft cheese
with 5% fat content suddenly start buying different kinds of breads and high-fat cheeses?
Is there more food than necessary in the fridge?
Is there food in the fridge that has gone bad?
Is the food that was bought stored in the appropriate place? Or do we suddenly find ice-cream
or frozen meat in the kitchen cabinet and fresh cucumbers in the freezer?
b. Preparing the meal
Does the person forget how to cook familiar dishes?
Does the person behave dangerously in the kitchen? Examples: Forgetting a pot on the gas, or
leaving a baking dish in a lit oven, or heating oil in the frying pan and forgetting it until there is the
smell of burnt oil, or pouring hot water from the kettle and getting burnt.
Does the person keep cooking rice over and over again, even when there is enough cooked rice?
Has the person stopped preparing cooked food?
c. Organizing the eating environment (such as setting the table)
Are meal times not organized, or does the person suddenly eat breakfast at noon and dinner at
two o’clock at night? Has there been an extreme change without a justified reason?
Does the person forget to eat or does he eat incessantly?
Has there been a change in eating habits or eating place – has the person suddenly begun to eat
in a place where he did not usually eat in the past, e.g. in the living room? In the bedroom? On
the porch?
Does the person have trouble getting organized to host meals, especially trouble setting the
table?
After the meal – is the table cleared as in the past? Are the dishes being washed? Is the leftover
food being stored? Are the dishes returned to their usual place?
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
15
d. Eating the food
Has there been a change in table manners at meal time? Does the person no longer care when
his clothes get dirty during a meal?
Has there been a change in the duration of the meal, e.g. eating very rapidly or the meal takes a
long time? Does the person not finish the meal?
Does the person eat very little?
Does the person eat a large meal and then say “I haven’t eaten a thing” or “I haven’t eaten”?
Does the person refuse to open his mouth? Does the person leave his mouth open all the time?
Does the person complain that food “gets stuck” in his throat? “I can’t swallow”?
Does the person leave the food in his mouth for a long time without swallowing? Chew for a long
time? Swallow fast without chewing?
Does the person cough while eating/drinking or immediately afterwards?
These warning signs could indicate a medical problem that
requires investigation and diagnosis – see the patient’s physician
at the Health Fund (kupat cholim).
Delayed diagnosis and treatment could make things worse.
16
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Tips and recommendations for coping with eating function
problems in persons with dementia
The Problem
Recommendations
a. Buying food
Unable to go grocery
shopping because he has
stopped driving
Find an appropriate time to drive him to grocery shopping or
encourage him to use public transportation.
Has trouble shopping
for groceries because of
weakness and difficulty
bringing the food home
Encourage him to use a shopping cart or to use a delivery
service or to shop on the Internet, with supervision and
support.
Does not remember: “What
did I want to buy?”
Leave a notepad with a pen or pencil at a fixed spot in the
kitchen and prepare a grocery list.
Take the grocery list when going shopping.
Difficulty managing money
A family member should set a fixed amount in advance, make
sure that the person with dementia goes shopping with the
grocery list, or accompany him on his shopping and pay for him.
Buys excessive amounts of
food, some of the food is not
healthy
Accompany him on his grocery shopping as often as possible.
We wish to check if there is
food that has gone bad and/
or not healthy in the fridge or
cabinet without hurting his
feelings
It is important to find an excuse to open the fridge or cabinet
without hurting the person’s feelings. Say out loud: “I’m going to
get a glass of milk from the fridge”.
We find on many occasions
food in the fridge that has
gone bad and very dirty
utensils, posing a health
hazard
Urgently consider the provision of assistance on a more intensive
basis.
b. Preparing the meal
The person forgets how to
cook familiar dishes
Prepare familiar recipes together, check together the recipe’s
ingredients and method of preparation, try to break down
the recipe into stages and select the stage that carries most
importance for the person. For example, when preparing cookies
– prepare dough in advance and have the person with dementia
only make the shapes.
The person forgets pots on
the gas, baking trays in the
oven, oil in the frying pan
Use an alarm clock to remind him when to turn off the oven or
the gas.
Use a gas stove that comes with a leak prevention mechanism –
check with the manufacturer. Another option – installing such
a mechanism. You can purchase such a mechanism at “Yad
Sarah”.
Consider using an electric stove – this prevents the risk of a gas
leak but does not prevent burns.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
17
The Problem
Recommendations
The person is not careful
when preparing hot
beverages
Make sure he can use an electric kettle/hot water urn/thermos
flask and remembers how to use it. Make sure that the person
can use these without getting a burn.
Repeatedly cooks the same
dish, even though the same
dish, recently prepared, is in
the fridge or on the counter
Requires attention. In this case, it is recommended to make sure
that there are not excessive amounts of raw ingredients at home,
such as bags of rice, flour or pasta.
Difficulty finding pots and
cooking utensils
Organize the kitchen so that the commonly used dishes and
cooking utensils are stored in an easily accessible place.
Remove items that are not in use.
Difficulty climbing or bending Organize the kitchen so that the utensils necessary for everyday
down in order to find cooking use are at hand without having to climb or bend down.
utensils
Under all circumstances, refrain from climbing a ladder or
standing on a chair without supervision, to prevent falls!
If dishes that are not in everyday use are needed, when hosting
for example, family members should get the dishes down from
high storage and bring them to the table.
Difficulty planning and
preparing a holiday meal
Prepare as early as possible and avoid cooking at the last
minute.
We also suggest making it easier and preparing a cake or
favorite family dish together, thus maintaining the person’s
dignity.
The person has stopped
preparing cooked food
Provide ready cooked food on a regular basis.
c. Organizing the eating environment
Disorganized meal times
Organize ready made meals with a note “breakfast”, “lunch”, and
call to remind the person to go to the fridge and get the proper
meal.
If the person still can, prepare a tracking table marked “I ate
breakfast”.
Change in the eating place
It is important to make sure that the eating place is suitable
for safe eating, that the way from the kitchen to the eating
place is clear of physical obstacles, and that the change in the
environment does not affect the food being eaten.
For example: if instead of healthy meals in the kitchen, the
person starts eating only in from of the TV, it is important to
make sure that there are no obstacles on the way to the living
room, that the couch is placed opposite a table and at the right
height , and that the person doesn’t eat only snacks and sweets
due to the environment.
Environmental factors that
interfere with eating
Pay attention to lighting, sitting comfort, the distance between
the chair and the table.
It is very important to eat in a quiet and calm setting with few
distractions, especially in the presence of agitation and/or
suspected swallowing problems.
18
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
The Problem
Recommendations
Difficulty setting the table
If the person finds it difficult to set the table as customary when
hosting, we recommend doing it together with the person, or
doing it instead of him, to allow him to host.
If the person is unable to set the eating environment for a simple
everyday meal – help is necessary!
Difficulty clearing the dishes
and washing them after a
meal
Help is necessary.
d. The actual act of eating
General: It is important to come for visits at mealtimes. Such visits can help maintain a schedule
and help the person eat a diversified and organized meal.
Difficulty using utensils
Sometimes, an adapted eating utensil – such as a plate fixed
to the table, a caring mug, personally adapted utensils* – can
facilitate eating functions and make it more convenient and safe
to eat. We recommend consulting with occupational therapists.
* For details on eating accessories, refer to the end of the
booklet.
Overeating
Organize the food in the fridge in sealed boxes to prevent
temptation to overeat.
It is very important that the food is not visible and available:
don’t leave a jar of cookies or candy in a visible and tempting
place. You can leave a bowl with sliced vegetables or some fruit
for snacking.
You can allow the person to eat small frequent meals to satisfy
the need to eat.
We recommend organizing an interesting occupation indoors and
outdoors to prevent unnecessary eating due to boredom.
If the problem is not serious and there is a little weight gain –
there is no room for concern. Sometimes it is even better that the
person is a little overweight (reserves). On the other hand, if the
“binging” problem gets worse and you lose control over matters,
you should try consulting a dietitian.
Strong need and desire to
eat sweets – chocolate,
cakes, candy...
Try giving small portions of sweets at a time so that the person
does not eat excessively: one piece of chocolate, one biscuit...
Offer other foods as well, sweet but healthier – such as a piece
of fruit or fruit salad, fruit yoghurt, chocolate milk, dried fruit (if
teeth condition allows)...
Change in table manners: the Help is necessary. Hand out napkins over the course of the meal,
person no longer cares if his wash his face, change clothes after the meal.
clothes get dirty
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
19
The Problem
Recommendations
Eats very little
Try to find out the reason: misfit teeth, depression/anxiety, acute
disease... In these cases, see the family physician.
Break up into small meals over the course of the day.
It is better to drink only after the meal and not before, so that the
person does not fill on water.
It is important to make sure that the food is appetizing – served
nicely, contrasting tastes, tempting colors and smells.The aroma
of food that is ready or being cooked arouses the person’s desire
to eat.
If the person wants to feed himself but is unable to hold utensils
(spoon, knife and fork), you can serve food that he can eat with
his hands (“finger food” – see details below).
When the food is not tasty, try finding out the reason – maybe
the food is not hot enough or cold enough, maybe it is missing
sugar, spicy seasoning or another favorite flavor.
Experience shows that breakfast is taken better than dinner.
However, if the person with dementia is awake and more active
at nighttime, offer him food at those hours as well.
Drinks little or refuses to
drink
For those who are alone for part of the day without help or
supervision, we recommend creating a routine of drinking from
water bottles. You can label each bottle according to the days of
the week and instruct the person with dementia to drink at least
the entire bottle of that day. This is like the pill box that helps
getting organized with taking medications at fixed times.
If your loved one refuses to drink, you can try telling him that
“the doctor said you have to drink!”
You can make drinking into a ritual or pleasant experience that
makes the person feel good, for instance: “Mom, I made us
a nice cup of coffee/tea the way you like it. It’s nice to drink
together.”
Holds the food in the mouth;
Chews for a long time;
Consultation may be necessary, focusing on the adaptation of
food textures and ways of eating and feeding.
Coughs while eating/drinking Persons with dementia need a longer meal time. It is
recommended to dedicate at least one hour for every meal.
or immediately afterwards
It is recommended to divide the meals into a larger number of
smaller meals throughout the day.
It is important to check that the mouth is empty at the end of the
meal.
Wait about 30-45 minutes after the meal before lying down.
See a physician, speech and language therapist and dietitian for
assessment and counselling.
20
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
It is important to monitor, obtain advice and adapt the solutions to the
changing situation:
• If a person has dementia, it is very important that his family or caregivers visit him as often as
possible and be aware of the changes that occur. These regular visits are vital and allow to
observe the person’s functioning and behavior.
• These visits are also important in order to identify danger, for example: a person who forgets a
pot on the stove, eats bad food from the fridge or a person who forgets to eat and drink – puts
his health and the health of those around him at risk to the point of mortal danger!
• When the family lives far from the relative with dementia: contact a neighbor or friend who
lives close by, and ask him to visit and observe the situation. It is important to alert the visitor’s
attention to the situations mentioned above.
If there is danger – constant help and escort is needed for the
various activities.
Consult a physician, nurse and social worker.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
21
Eating with fingers – “finger food”
Often enough, persons with dementia find it difficult to eat independently with a knife and
fork. There can be many reasons for this: sometimes the person with dementia is unable
to understand the function of the knife and fork, and sometimes he experiences motor
difficulties, such as hand tremors or he is unable to hold a knife. In these cases, it is important
to allow the person to try eating “finger food”.
Finger food is food that you can eat with your hands.
When this food is served to a person with dementia, we help him feel that he is independent, and
can eat by himself and feel that he is still in control of his eating.
Finger food can be an entire meal or part of a meal, for example: a slice of bread, a piece of fruit
or vegetable or French fries.
You can give finger food at all meals and also in between meals.
It is important to adapt the food to the person’s preferences and to his ability to chew (or offer
soft foods when these are needed).
22
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Example of a daily menu of 5 meals a day as recommended,
composed entirely of finger food (except for the beverages).
Breakfast:
Hard or filled egg (for example with avocado, tahini, mayonnaise) or slices of omelet.
Sandwich cut into small pieces with avocado, tahini, hummus, peanut butter, mayonnaise, butter,
soft cream cheese, melted cheese, hard cheese, sardines or tuna in oil, omelet, egg salad, halva,
matbucha (cooked tomato salad) or Turkish salad and any appetizing food that makes the person
want to eat.
Fresh, sliced vegetables, such as: tomato, cucumber, pepper of different colors, radish, kohlrabi,
carrot.
Beverage.
Mid-morning snack:
Sliced seasonal fruits in different colors, for example: apple, watermelon, cantaloupe, peach,
orange, banana, strawberry.
Lunch:
Cooked or baked potato, in slices that are convenient to hold with the fingers.
Wide noodles/pasta that it is easy to pick up with the hands, in thick sauce.
Cooked favorite vegetables – pieces of zucchini, carrot, cauliflower, pumpkin, sweet potato,
green and yellow beans, fava beans, peas...
Fried or baked fish fingers; slices of chicken; cut schnitzel; all types of minces – such as: leek;
beef, chicken, turkey or fish balls or cutlets; stuffed kubbeh; small chicken drumstick; pancakes
made of pulses...
Beverage.
Afternoon snack:
Cut sandwich or fruit or piece of cake or cookie that is easy to hold.
Dinner:
The same as breakfast, or make variations and add foods such as:
Cubes of hard cheese or melted cheese.
Pies cut into small pieces or baked in a muffin pan.
Pizza squares, cut pancake or crepes (blinches),
stuffed vine leaves.
Whole sardines or mackerels; strain the oil.
Beverage.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
23
How to handle constipation
As noted previously, many people, in particular the elderly, complain of constipation, which might
be accompanied by abdominal pain, fullness and flatulence and the need to strain on the toilet
(which could cause hemorrhoids and bleeding) – all these effects and sensations cause loss of
appetite. Persons with dementia are sometimes unable to express in words their complaint that
they are constipated, but sometimes we can see that they are constipated by their facial and body
expressions.
Why does this happen and what to do?
The digestive system slows down as we age; use of certain medications can aggravate the
situation.
Due to eating too little, and in particular a diet that is not rich in fiber (see below regarding how
to increase fiber intake in food).
When the person doesn’t drink enough – the stool becomes hard – see below explanation on
the importance of drinking.
Inactivity and extended periods of sitting make the bowels “lazy” – the person should be
encouraged as much as possible to engage in physical activity suitable for him, after consulting
the physician and physiotherapist.
The person sometimes forgets to go to the toilet and then the stool becomes harder. Therefore,
it is very important that the person gets used to going to the toilet regularly, for example: if he is
used to go to the toilet after breakfast, keep this habit.
If all attempts to treat the problem using the methods specified above are unsuccessful,
consult the physician.
24
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Natural dietary fiber prevents constipation!
Many foods contain fiber, which helps digestion and helps balance blood sugar and lipid levels.
Making sure to drink sufficient fluids, as well as eating high-fiber foods, is important in preventing
constipation. It is highly recommended to include these foods in the daily diet. These foods are in the
grains group and in the fruit and vegetables group as well as in pulses.
Whole grains: whole wheat and whole wheat breads, oatmeal, whole rice, whole wheat noodles
and pasta, buckwheat, groats (bulgur), cracked wheat, whole semolina, corn.
Pulses: beans of all colors and kinds, peas, chickpeas, lupine bean, lentils, black-eyed peas,
fava bean.
Fruit and Vegetables of all colors and kinds. Wash them well and serve unpeeled, if possible.
At meals and between meals, it is recommended to eat fresh fruit and vegetables: you can slice
them and serve as an alternative to salty snacks – slices of cucumber, carrot and celery sticks,
slices of seasonal fruit etc.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
25
Drinking – important and also helps prevent constipation
Many people don’t feel the need to drink or sometimes forget to drink. Insufficient fluids can cause
confusion, fatigue, headaches, constipation and urinary tract infections. Drink copious amounts of
water throughout the day, at meal times and between meals. Below are several tips for encouraging
the person to drink:
What is the recommended amount of water to drink? It depends on the weather, the amount
of salt we eat, body weight and physical exercise. In hot weather – we sweat a lot and need to
drink more; you can also tell by the color of the urine: if it’s light colored, this indicates that we
drank enough. If it’s yellow or dark, we need to drink more.
When to drink Serve beverages at meal times and also between meals.
What to drink It is best to serve water at the temperature that the individual prefers: some prefer
cold water (mainly in summer) and others prefer water at room temperature. Offer a beverage
with a different and interesting flavor each time: you can add flavor to the water with a slice of
lemon or mint leaf. It is preferable to use a transparent glass, so you can see its contents. Explain
what’s in the glass and at which temperature: “Dad, I brought you a glass of cold water/ hot tea
with sugar/ fresh orange juice.”
26
•
Tip: At advanced stages of the disease, sweetened beverages are also an option, to
encourage the person to drink.
•
Moderately drink regular and green tea, coffee, chocolate milk, coke and energy drinks, in
amounts that are not excessive, since they contain caffeine. Too much caffeine can result
in difficulty falling asleep at night or at noon, disquiet, agitation, tremors, frequent urination,
irregular heart rhythm, digestive problems etc.
•
Alcohol consumption: Small quantities of alcohol (such as a glass of wine or beer) are
usually harmless, but regular consumption of large quantities of alcohol causes confusion,
disquiet and agitation and serious physical harm.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Going up a notch –
when dementia progresses
The progression of the disease is gradual and individual. The person may still be able to eat
independently but need to have food served on his plate. Sometimes, verbal encouragement may be
sufficient. If this is the case, it is best to simply and kindly remind the person: “eat please”.
As the disease progresses, the time comes when the person is unable to remember the steps of
eating and does not even understand the instruction “eat please”. These changes will necessitate
changes in the foods themselves, in their composition and in the methods of feeding.
It is important to be alert at mealtimes: If the person coughs during meals or immediately afterwards,
this may indicate a swallowing problem (see details below). If this is the case, it is important to see
the family physician and bring his attention to the fact that there might be a swallowing problem and
suggest a consultation with an ENT (ear, nose and throat) specialist and a speech and language
therapist.
Pain, constipation and oral problems: As indicated above – these conditions are very common
among the elderly, particularly among dementia patients, and could get worse in the advanced stages
of the disease. At the same time, the patient’s ability to express pain or discomfort diminishes due
to these conditions, and therefore it is important to initiate monitoring and treatment even without
explicit complaints on the patient’s part.
Medications: In the advanced stages of dementia, the use of medications generally increases,
particularly medications that affect behavior or relieve pain – and there are more side effects, which
might cause impaired alertness, loss of appetite or difficulty swallowing. All of these have a direct
influence on eating.
Teeth: The person with dementia could have problems with their teeth just like anyone else, but in the
advanced stages of the disease, he will have trouble expressing himself and pointing to the source
of the problem. This in turn will cause late diagnosis and delayed treatment, and the problem will
worsen to the to the point of causing pain, difficulty chewing, refusal to eat, weight loss, restlessness,
introversion and other behavioral changes. Prevention – it is important to construct a personal
treatment plan with the dentist, tailored for the person with dementia. It is important to pay attention
to signs such as a broken or loose tooth, misfitting dentures, sores in the oral cavity, or indeed any
behavioral change that appears close to meal times or during meal times which could indicate dental
problems.
Xerostomia (dry mouth): Xerostomia is common in diseases such as diabetes and as a side effect
of some medications, such as medications against high blood pressure, allergy, depression etc.
Xerostomia can cause difficulty chewing and swallowing, damage to teeth, thrush and even impaired
speech. Make sure to drink plenty of fluids, maintain oral hygiene and consult the patient’s physician.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
27
Changes in eating and swallowing as a
manifestation of dementia progression
Changes in the cognitive state and changes in state of consciousness in the person with
dementia could manifest as drowsiness, being less connected with his surroundings, inability to
express himself and his wishes, and lack of understanding of the eating situation and of the stages
of eating.
Sensory impairment – As the disease progresses, there is diminished reaction to the sense of taste,
of smell and to the sounds of the eating utensils, which are typically the initial stimulation before
swallowing.
Swallowing problems – Swallowing is the process of transferring food through the mouth into the
pharynx (throat) and from there to the stomach. Swallowing is a complex process, involving an entire
system of muscles and nerves.
As the disease progresses, nerves and muscles involved in the eating and swallowing process are
affected. This causes swallowing problems that can affect nutrition, and at the same time can cause
food to enter the lungs, resulting in cough and asphyxiation when eating, recurring pneumonia, and
can be life threatening.
What are the signs of a swallowing problem?
The person reports food getting stuck in his throat
Recurring disease of the airways, such as pneumonia
Unexplained fever
Marked weight loss
The person coughs or clears his throat when eating and/or drinking
Change in breathing or strained breathing when swallowing
The person holds the food in the mouth
The person refuses to eat
Food remains in the mouth after swallowing
One or more of these signs may indicate a swallowing problem!
See the patient’s physician without delay – for investigation and
appropriate treatment
28
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Practical advice and tips that are useful
before, during and after meals –
at the advanced stages of dementia:
As the patient’s condition worsens, the need grows for the presence of another person to assist
throughout the day and often through the night as well. At this stage, the caregiver is often required
to help not only in the preparation of food and in organizing the environment, but also with the act of
eating itself.
Before the meal:
Make sure the person with dementia is as alert as possible. We recommend doing anything that,
from your experience, wakens your loved one, such as: talking to him, playing favorite music,
gently touching the face and hands...
Notice the posture in which the person is sitting: make sure that the person is in a position which
is closest to sitting. It is especially important that the head be upright and not dropped.
Keep a habit of eating in specific places in the house, such as the kitchen, dining room or garden.
Make meal times pleasant by changing or adapting the eating environment: such as eating next
to a table (even if he does not feed himself), turning on a pleasant light or opening the shades/
window, quiet relaxed atmosphere or playing appropriate music.
Check whether the person with dementia prefers to eat with or without dentures.
Make sure that if he is used to eyeglasses and a hearing aid, he uses them during meal times as
well.
Make sure the mouth is moistened/wet before beginning the meal. You can drop several drops of
sugar water.
Saliva production can be stimulated by using an adult teether, like the kind used for babies when
they are teething. Biting stimulates saliva production and preserves the mobility of the muscles
of the mouth.
Make sure to prepare food of a texture that suits the patient’s condition. Use appropriate
appliances for preparing the food, such as: food processor, blender, hand blender, grater.
Serves at least six meals a day.
If the person is sometimes more alert at night, you can take advantage of this by timing a meal
to coincide with this enhanced alertness.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
29
During the meal
Never compel the person to eat or force his mouth open against his will.
While eating, talk to the person and explain what you are going to do together. It is important to
speak in short sentences: “Now we are going to eat ice cream”.
It is important to maintain eye contact during the meal to encourage interpersonal communication.
Pay attention to verbal reactions, facial expressions and body language in reaction to the food.
This way we can identify pleasure, comfort, pain, suffering.
Speak gently and calmly to alleviate concerns and fears. It is important to understand that the
person may not understand that he is now in an eating situation and he may not recognize
objects, so he might be frightened when he sees a spoon approaching his mouth.
Suitable food textures: change the texture of the food to accommodate the person’s general
medical condition and his swallowing ability. For example, if it is hard for him to chew hard and
solid food (such as: apple/beef/cucumber), switch to softer food texture (cooked cutlets/cooked
vegetables/cooked fish with sauce). If eating and swallowing abilities diminish significantly,
switch to a thick and homogenous pureed texture, such as apple puree/food mashed in the
blender or dairy dessert.
Allow a break between one spoonful and the next. Remind the person to swallow.
If he coughs during the meal – see the patient’s physician and if necessary, see a speech and
language therapist for assessment of swallowing functions.
After the meal
It is important to maintain oral hygiene and cleanliness: clean food residue that remains in the
mouth and wash dentures (if any). Use a soft brush and a toothpaste that the person likes and is
used to.
Cleaning of the oral cavity must be done gently and carefully so as not to induce vomiting or
cause an injury.
Do not let the person lie down immediately after the meal, in order to allow food to digest and to
prevent food from entering the windpipe and lungs.
30
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Tips and advice – what to eat in the
advanced stages of the disease
In respect of patients with dementia who have problems with nutrition and eating, it is important
to focus as much as possible on improving the quality of life through nutrition. This is not
the right time to be strict about sugar or salt intake or about weight loss diets. Allow the person
to eat what he loves and enjoys.
In general, it is best to serve food that is seasoned with diverse spicy, sweet, sour flavors,
depending on his personal taste. Seasoned food is appetizing, keeps the person alert and
encourages him to swallow.
When he has mouth sores, avoid excessive seasoning and avoid food that is too spicy or too
sour.
Depending on his condition, you can try and engage the person in the choice of foods from the
list of options attached below.
It is very important to make sure to drink throughout the day.
At these stages, you may have to switch to drinking using a straw, a bottle or a special cup,
or even with a spoon. We recommend consulting with occupational therapists to select the
appropriate aid.
Nevertheless, take note that liquids can sometimes cause coughing, so you can use a thickening
agent, which you can buy at the pharmacy, following consultation with a speech and language
therapist.
Food and beverage temperature: make sure that the food you serve is neither too hot nor too
cold. Food which is too hot can cause burns; food which is too cold can cause cramps of the
muscles of the mouth. In addition, for many people, heat and cold can cause pain due to gum
inflammations, cavities and dentures.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
31
Soft and nutritious foods
for people with eating, chewing and swallowing problems
Breakfast or dinner:
Porridge with added: sugar or honey, sweet or sour cream, jam, chocolate.
Dairy dessert in various flavors.
Cooked pudding based on whole milk with cream.
Spreads: avocado, tahini, hummus, smooth peanut butter, egg salad with mayonnaise, soft
cream cheese, tuna salad with oil mashed in the blender.
Lunch:
Mashed potatoes/sweet potatoes with gravy.
Thick and smooth soups without vegetable pieces, with added pulses (such as lentils or peas),
rice, barley groats, pasta. You can add egg drops to the soup.
Pureed fish, chicken or turkey with gravy.
Between meals (“mid-morning snack” and “afternoon snack”):
Apple sauce with added sugar, honey etc. (as for porridge), smooth peanut butter without pieces
of peanuts, raw tahini.
Fruit or ice cream mashed in the blender with juice, milk or sweet cream (milkshake), mashed to
a smooth, homogeneous texture.
Halva spread (can be prepared by mixing date honey or honey with raw tahini).
Ice creams and popsicles.
When you want to enrich the diet, prefer regular food over using preparations or dietary
supplements and oral nutritional supplements. When there is no choice, integrate the
supplements into the menu – it is important to consult a dietitian.
32
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
In the advanced stages of dementia, you may feel
that it is very hard to take care of your loved one’s
nutrition.
There may be situations where there is significant
weight loss or when you notice that despite that vast
amount of time you invest in feeding, the amount of
food that your loved one is eating is very small.
It is a good thing to seek the help of professionals
under such circumstances. The family physician or
the nurse at the clinic will guide you to appropriate
consultation so you can find the most appropriate way
to help your loved one.
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
33
34
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
35
Principles of healthy nutrition
Healthy nutrition combined with physical activity is important at all
ages. The food pyramid demonstrates this.
Structure of the food pyramid
You can look at the food pyramid from inside or from outside. Inside the pyramid = recommendations
for nutrition; everything around it = recommendations for physical activity.
Physical activity combined with proper nutrition = recipe for good health.
The Food Pyramid –
Making the Transition to Healthy Living!
The basis for proper nutrition and physical activity
Consume
sparingly
moti
h Pro
Healt
on
Ministry of Health
Public Health Services
Candy
Snacks
Sweet drinks
High-fat
foods
Vary every
day
Protein rich
foods
Fruit and
vegetables
Grains and
pulses
Consume in
quantity
Water
Physical activity and proper nutrition - A recipe for good health
36
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Inside the pyramid:
The pyramid consists of six levels, each containing a different food group: five levels with groups of
recommended foods, and a sixth level, containing foods that the
body doesn’t need.
The quantities of the recommended foods are described in the
following manner: you should eat less the higher you are toward
the top of the pyramid.
For example: you should eat more from the grain family (such as
bread) than from the high-fat foods. Each level of the pyramid
consists of food groups:
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
37
Food groups
The six food groups of the pyramid:
Water
Ta p w a t e r i s r e c o m m e n d e d f o r c o n s u m p t i o n
spend money on purchasing and transporting bottled water.
and
it
is
a
waste
to
Grains and pulses
For example, bread, noodles, rice, potatoes, corn, barley groats, semolina, oatmeal, etc.
We recommend choosing whole grains, for instance: whole wheat bread, whole rice, unpeeled
potatoes, whole wheat, oatmeal, etc. These grains are rich in fiber, vitamins and minerals.
Fruit and vegetables
We recommend eating at least five unpeeled fruits and vegetables of various
colors every day, for example, three vegetables and two fruits.
Protein rich foods
Meat and poultry products, dairy products, eggs, pulses and fish.
It is important that every meal contains at least one serving from this group – for example, dairy
products or egg in the morning and in the evening, and at lunchtime, chicken, fish or pulses.
High-fat foods
For example: avocado, tahini, oil, olives, mayonnaise, nuts and peanuts. When preparing food, it is
better to use canola oil or olive oil than butter or margarine.
Candy, snacks, sweet drinks
This group is not recommended, but as aforesaid,
it is an occasional source of pleasure for many people.
Note: As noted above, in persons with advanced dementia, do not be strict about avoiding
this food group.
38
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
Eating and Living With Dignity A practical guide for caregivers and family members of persons with dementia
Information and Recommendations
39
You are not alone
At any stage and in any situation, you don’t have to cope with the problem alone. Seek the help of
professionals. The family physician can diagnose problems that arise, and as necessary, refer you
to a dietitian, an occupational therapist, a speech and language therapist. You can also consult, as
necessary, a nurse or social worker.
Who do I contact?
The Health Funds (kupot cholim)
As noted above, when you experience some difficulty, we recommend that you see a professional at
the Health Fund with which the person with dementia is insured.
Below are the telephone numbers and website addresses of the four Health Funds:
Clalit Health Services *2700
http://www.clalit.co.il
Maccabi Healthcare Services *3555 http://www.maccabi4u.co.il
Meuhedet Health Fund *3833
https://www.meuhedet.co.il
Leumit Health Fund *507
http://www.leumit.co.il
Information and support on dementia
Information on dementia and Alzheimer's disease on the Ministry of Health website
http://www.health.gov.il/Subjects/Geriatrics/Dementia/Pages/default.aspx
EMDA – the Alzheimer's Association of Israel- http://www.alz-il.net Tel. *8889 Tel. – 1700-700-204
Melabev Association– www.melabev.org.il Tel. 1-700-70-4533
Eating accessories
You can consult an occupational therapist at the Health Fund regarding the accessories appropriate
for the condition of the person with dementia.
You can look at possible accessories on:
Milbat Association – www.milbat.org.il Tel. – 07-22230007
Azarim website – http://www.azarim.org.il
Yad Sarah – http://www.yadsarah.org.il/ see exhibition and counselling centers
General information
Varied information on old age on the Ministry of Health website
http://www.health.gov.il/Subjects/Geriatrics/Pages/default2.aspx
Information on rights and services for the elderly on the Ministry of Health website
http://www.health.gov.il/Subjects/Geriatrics/rights_and_services_for_elderly/Pages/default.aspx
Reuth Eshel Association – http://www.reutheshel.org.il/